Contribution of public oral pathology services to the diagnosis of oral and oropharyngeal cancer in Brazil.

This study aimed to evaluate the contribution of oral and maxillofacial pathology laboratories (OMPLs) in Brazilian public universities to the diagnosis of lip, oral cavity, and oropharyngeal squamous cell carcinoma (SCC). A cross-sectional study was performed using biopsy records from a consortium of sixteen public OMPLs from all regions of Brazil (North, Northeast, Central-West, Southeast, and South). Clinical and demographic data of patients diagnosed with lip, oral cavity, and oropharyngeal SCC between 2010 and 2019 were collected from the patients' histopathological records. Of the 120,010 oral and maxillofacial biopsies (2010-2019), 6.9% (8,321 cases) were diagnosed as lip (0.8%, 951 cases), oral cavity (4.9%, 5,971 cases), and oropharyngeal (1.2%, 1,399 cases) SCCs. Most cases were from Brazil's Southeast (64.5%), where six of the OMPLs analyzed are located. The predominant profile of patients with lip and oral cavity SCC was Caucasian men, with a mean age over 60 years, low schooling level, and a previous history of heavy tobacco consumption. In the oropharyngeal group, the majority were non-Caucasian men, with a mean age under 60 years, had a low education level, and were former/current tobacco and alcohol users. According to data from the Brazilian National Cancer Institute, approximately 9.9% of the total lip, oral cavity, and oropharyngeal SCCs reported over the last decade in Brazil may have been diagnosed at the OMPLs included in the current study. Therefore, this data confirms the contribution of public OMPLs with respect to the important diagnostic support they provide to the oral healthcare services extended by the Brazilian Public Health System.

Contribution of public oral pathology services to the diagnosis of oral and oropharyngeal cancer in Brazil

Abstract This study aimed to evaluate the contribution of oral and maxillofacial pathology laboratories (OMPLs) in Brazilian public universities to the diagnosis of lip, oral cavity, and oropharyngeal squamous cell carcinoma (SCC). A cross-sectional study was performed using biopsy records from a consortium of sixteen public OMPLs from all regions of Brazil (North, Northeast, Central-West, Southeast, and South). Clinical and demographic data of patients diagnosed with lip, oral cavity, and oropharyngeal SCC between 2010 and 2019 were collected from the patients' histopathological records. Of the 120,010 oral and maxillofacial biopsies (2010-2019), 6.9% (8,321 cases) were diagnosed as lip (0.8%, 951 cases), oral cavity (4.9%, 5,971 cases), and oropharyngeal (1.2%, 1,399 cases) SCCs. Most cases were from Brazil's Southeast (64.5%), where six of the OMPLs analyzed are located. The predominant profile of patients with lip and oral cavity SCC was Caucasian men, with a mean age over 60 years, low schooling level, and a previous history of heavy tobacco consumption. In the oropharyngeal group, the majority were non-Caucasian men, with a mean age under 60 years, had a low education level, and were former/current tobacco and alcohol users. According to data from the Brazilian National Cancer Institute, approximately 9.9% of the total lip, oral cavity, and oropharyngeal SCCs reported over the last decade in Brazil may have been diagnosed at the OMPLs included in the current study. Therefore, this data confirms the contribution of public OMPLs with respect to the important diagnostic support they provide to the oral healthcare services extended by the Brazilian Public Health System.

Oral leukoplakia, leukoerythroplakia, erythroplakia and actinic cheilitis: Analysis of 953 patients focusing on oral epithelial dysplasia.

BACKGROUND: To analyse the clinical and histological characteristics from a series of oral leukoplakias, leukoerythroplakias, erythroplakias and actinic cheilitis diagnosed in a 14-year period. METHODS: The files were reviewed and all cases diagnosed as leukoplakia, leukoerythroplakia, erythroplakia and actinic cheilitis were selected. Clinical information was obtained from the biopsy submission forms, and histological review was performed in all cases. RESULTS: Final sample included 953 lesions, mostly affecting females (534, 56%), and 87.5% of the patients were 41 to 80 years old. The most commonly affected regions were the lower lip (20.1%), tongue (18.1%) and buccal mucosa (16.9%). Leukoplakias, actinic cheilitis, leukoerythroplakias and erythroplakias represented, respectively, 74.6%, 15.2%, 9.3% and 0.8% of the sample. Most cases presented no dysplasia (42.1%) or mild dysplasia (33.5%). Lesions in the tongue, floor of mouth and lower lip, as well as lesions that presented hyperparakeratosis, showed higher frequencies of moderate dysplasia and severe dysplasia/carcinoma in situ. The most common histological criteria were the increase in number and size of nucleoli, loss of polarity of the basal cells and variations in cellular size and shape. Classification by the binary system showed that 7% were high-risk lesions. CONCLUSION: All histological criteria for classification of oral epithelial dysplasia recommended by the World Health Organization showed increased frequency as grading increased. Additional criteria seem to be useful in grading oral epithelial dysplasia, such as the presence of normal and abnormal superficial mitotic figures and endophytic epithelial proliferation.

Oral and oropharyngeal diffuse large B-cell lymphoma and high-grade B-cell lymphoma: A clinicopathologic and prognostic study of 69 cases.

OBJECTIVE: The objective of this study was to describe the clinicopathological, molecular, and prognostic features of oral/oropharyngeal diffuse large B-cell lymphoma (DLBCL) and high-grade B-cell lymphoma. STUDY DESIGN: All cases were retrieved from 7 Brazilian institutions. Immunohistochemical reactions were performed to confirm the diagnoses and to categorize the tumors. In situ hybridization was used to detect Epstein-Barr virus (EBV) and fluorescence in situ hybridization was used to identify gene rearrangements. RESULTS: Most cases involved the oral cavity (76.8%). Males and females, with a mean age of 60 years, were evenly affected. Tumors mostly presented as painful swellings. Forty cases represented germinal center B-cell type (58%). Five cases presented double-hit translocation and 3 harbored rearrangement for MYC/BCL2/BCL6. EBV was detected in 3 cases (4.3%). The 5-year overall survival was 44.4%. Female sex, presence of pain and ulcer, microscopic "starry sky pattern" and necrosis, co-expression of c-Myc/Bcl2, and translocation of MYC were associated with a lower survival in univariate analysis (P = .05, P = .01, P = .01, P = .03, P = .05, P = .006, P = .05, respectively). CONCLUSION: Patients affected by oral/oropharyngeal DLBCL have a low survival rate. High-grade B-cell lymphoma (17.7%) and EBV-positive DLBCL, not otherwise specified (4.3%) account for a small number of cases.

Clinical and radiological analysis of a series of periapical cysts and periapical granulomas diagnosed in a Brazilian population.

BACKGROUND: Periapical cysts (PC) and periapical granulomas (PG) are the two most common chronic inflammatory periapical diseases, but their clinicoradiological characteristics can vary depending on the methods employed in each study. The aim of the present work was to analyze the clinical and radiological profile of a series of PC and PG diagnosed in a Brazilian population. MATERIAL AND METHODS: The files of two Oral Pathology laboratories were reviewed and all cases diagnosed as PG and PC were selected for the study. Clinical and radiological information were retrieved and data were tabulated and descriptively and comparatively analyzed. RESULTS: Final sample was composed by 647 inflammatory periapical lesions, including 244 PG (38%) and 403 PC (62%). The number of women affected by PG was significantly higher than the number of women affected by PC (p=0.037). Anterior region of the maxilla was the most common affected area for both entities (39% of the cases), but the most common anatomical location of PG (anterior maxilla and posterior maxilla) was different from PC (anterior maxilla and posterior mandible) (p<0.0001). Upper lateral incisor was the most affected tooth. The mean radiological size of the PC was larger than the mean radiological size of the PG (p<0.0001) and PC showed well-defined radiological images more frequently than PG (p<0.0001). CONCLUSIONS: PC were more common than PG, both showed predilection for adult females, most lesions affected predominantly the anterior maxilla and PC presented larger mean radiological diameter and well-defined images when compared with PG. Key words:Periapical granuloma, periapical cyst, radicular cyst, diagnosis, Oral Pathology.

Clinicopathological characteristics of tumours of the intraoral minor salivary glands in 170 Brazilian patients.

Tumours of the minor salivary glands are relatively uncommon, and publications from around the world normally include tumours of both the minor and major salivary glands, making it difficult to assess their prevalence and distribution. Our aim was to evaluate retrospectively the clinicopathological features of a series of tumours of the intraoral minor salivary glands from two universities in Rio de Janeiro, Brazil, and to compare the data with those from other epidemiological studies. A total of 170 such tumours were diagnosed from 1942 to 2012, and were selected from two university departments of oral pathology. Eighty-nine of the tumours were benign (52%). Pleomorphic adenoma (n=75) and mucoepidermoid carcinoma (n=23) were the most common benign (44%) and malignant tumours (14%), respectively. There were 104 female patients (61%) and both benign and malignant tumours affected more women than men. Significantly more tumours were in the palate (n=95, 56%; p=0.001). We conclude that these tumours had features similar to those from other studies from North and Latin America, but differ from the results presented from Asia. Further studies should be designed to highlight possible geographical and population-specific characteristics of these tumours.

Clinical and laboratorial profile and histological features on minor salivary glands from patients under investigation for Sjögren's syndrome.

UNLABELLED: Diagnosis of Sjögren's syndrome (SS) is complex and the usefulness of labial minor salivary glands biopsy in this process remains controversial. OBJECTIVE: to evaluate the clinical and laboratorial profile and histological features on labial minor salivary glands from patients under investigation of SS. STUDY DESIGN: clinical charts from 38 patients under suspicion of SS and submitted to labial minor salivary glands biopsies were reviewed. Clinical and laboratorial data were retrieved from the clinical files and the HE-stained histological slides were reviewed under light microscopy. RESULTS: mean age of the patients was 56.5 years and 97% were females; histological analysis showed that 42% of the cases showed ductal dilatation, lymphocytic foci were found in 52.6% and, from this group, 80% of the cases presented a foci/lobules ratio above 0.8. Acinar/ductal ratio was considered diminished in 39.5% of the samples. Thirty six (95%) and 32 (84%) patients, respectively, complained about xerostomia and xerophthalmia. A study of the time interval of the symptoms that led to SS investigation showed a mean of 116 months. Moreover, sixty-six percent of the patients had already been submitted to immunosuppressive therapy prior to the labial minor salivary gland biopsy. Age of the patients, scintigraphic alterations on salivary function, antinuclear factor (ANF), anti-Ro and anti-La did not show statistical significant association with the histological features. Lobules/foci ratio above 0.8 was the only histological parameter statistically associated with Sjögren's syndrome diagnosis (p<0.0001). CONCLUSIONS: in the studied sample, lymphocytic foci on salivary glands were the only histological parameter associated to the diagnosis of SS. Early indication of labial minor salivary gland biopsy to patients under investigation of SS could limit the effects of immunosuppressive therapy on the histological features associated with the evolution of salivary gland involvement in SS.

Oral squamous cell carcinoma: clinicopathological features from 346 cases from a single oral pathology service during an 8-year period.

UNLABELLED: Epidemiological data from oral squamous cell carcinoma (OSCC) is mostly derived from North American, European and East Asian populations. OBJECTIVE: The aim of this study was to report the demographic and clinicopathological features from OSCC diagnosed in an Oral Pathology service in southeastern Brazil in an 8-year period. MATERIAL AND METHODS: All OSCC diagnosed from 2005 to 2012 were reviewed, including histological analysis of all hematoxylin and eosin stained slides and review of all demographic and clinical information from the laboratory records. RESULTS: A total of 346 OSCC was retrieved and males represented 67% of the sample. Mean age of the patients was 62.3 years-old and females were affected a decade older than males (p<0.001). Mean time of complaint with the tumors was 10 months and site distribution showed that the border of the tongue (37%), alveolar mucosa/gingiva (20%) and floor of mouth/ventral tongue (19%) were the most common affected sites. Mean size of the tumors was 3.4 cm, with no differences for males and females (p=0.091) and males reported both tobacco and alcohol consumption more frequently than females. Histological grade of the tumors revealed that 27%, 40% and 21% of the tumors were, respectively, classified as well-, moderately- and poorly-differentiated OSCC, 26 cases (7.5%) were microinvasive OSCC and 17 cases were OSCC variants. OSCC in males mostly affected the border of tongue, floor of mouth/ventral tongue and alveolar mucosa/gingival, while they were more frequent on the border of tongue, alveolar mucosa/gingival and buccal mucosa/buccal sulcus in females (p=0.004). CONCLUSIONS: The present data reflect the epidemiological characteristics of OSCC diagnosed in a public Oral Pathology laboratory in southeastern Brazil and have highlighted several differences in clinicopathological features when comparing male and female OSCC-affected patients.

Oral squamous cell carcinoma: clinicopathological features from 346 cases from a single Oral Pathology service during an 8-year period

Epidemiological data from oral squamous cell carcinoma (OSCC) is mostly derived from North American, European and East Asian populations. OBJECTIVE: The aim of this study was to report the demographic and clinicopathological features from OSCC diagnosed in an Oral Pathology service in southeastern Brazil in an 8-year period. MATERIAL AND METHODS: All OSCC diagnosed from 2005 to 2012 were reviewed, including histological analysis of all hematoxylin and eosin stained slides and review of all demographic and clinical information from the laboratory records. RESULTS: A total of 346 OSCC was retrieved and males represented 67% of the sample. Mean age of the patients was 62.3 years-old and females were affected a decade older than males (p<0.001). Mean time of complaint with the tumors was 10 months and site distribution showed that the border of the tongue (37%), alveolar mucosa/gingiva (20%) and floor of mouth/ventral tongue (19%) were the most common affected sites. Mean size of the tumors was 3.4 cm, with no differences for males and females (p=0.091) and males reported both tobacco and alcohol consumption more frequently than females. Histological grade of the tumors revealed that 27%, 40% and 21% of the tumors were, respectively, classified as well-, moderately- and poorly-differentiated OSCC, 26 cases (7.5%) were microinvasive OSCC and 17 cases were OSCC variants. OSCC in males mostly affected the border of tongue, floor of mouth/ventral tongue and alveolar mucosa/gingival, while they were more frequent on the border of tongue, alveolar mucosa/gingival and buccal mucosa/buccal sulcus in females (p=0.004). CONCLUSIONS: The present data reflect the epidemiological characteristics of OSCC diagnosed in a public Oral Pathology laboratory in southeastern Brazil and have highlighted several differences in clinicopathological features when comparing male and female OSCC-affected patients. .

Histopathological features of keratocystic odontogenic tumor: a descriptive study of 177 cases from a Brazilian population.

The aim of this study was to describe the clinicopathologic features of 177 keratocystic odontogenic tumors (KCOTs) diagnosed in a Brazilian population. A total of 177 KCOTs were reviewed and affected 158 patients with ages ranging from 5 to 79 years (mean age = 32 years) with a slight female predominance. Mandible was the most common affected site (69.3%), and a unilocular radiolucency was the most common radiographic image. Microscopically, all cases showed at least focal areas of classic KCOT, but several histological aspects were also observed, including diffuse and focal epithelial lining hyperplasia (48.6%), epithelial budding (12.4%), reactive cytological alterations (11.3%), dystrophic calcification (7.9%), daughter cysts (7.8%), odontogenic epithelial remnants (4.5%), focal areas of orthokeratinization (2.8%), and ameloblastomatous epithelium (1.7%). These variations may make KCOT diagnosis challenging in some cases, so careful full-sample analysis and knowledge of these uncommon histological features associated with KCOT are essential for correct diagnosis.

Cisto do ducto nasopalatino: considerações microscópicas e de diagnóstico diferencial / Nasopalatine duct cyst: microscopic and differential diagnosis considerations

Os cistos do ducto nasopalatino são entidades incomuns dos maxilares, mas que podem assemelhar-se clínica e radiograficamente a outras lesões císticas e sólidas da região anterior mediana da maxila. O objetivo deste trabalho foi reportar 4 casos de cisto do ducto nasopalatino buscando discutir suas características microscópicas e de diagnóstico diferencial relevantes na prática clínica odontológica. As informações demográficas, clínicas e imaginológicas foram obtidas a partir dos registros laboratoriais dos pacientes e as lâminas histológicas coradas em hematoxilina e eosina dos 4 casos foram revisadas sob microscopia ótica. Os 4 casos acometeram homens com média de 53 anos de idade e todas as lesões eram assintomáticas. As imagens radiográficas eram radiolúcidas uniloculares, localizadas entre os incisivos centrais superiores e com tamanho médio de 2,0 cm (variando de 1,0 a 4,0 cm). Todos os casos foram tratados através de enucleação cirúrgica e a análise microscópica revelou que 3 dos 4 casos eram revestidos por mais de um tipo de epitélio, sendo o epitélio pavimentoso estratificado não queratinizado o mais comum. Conclui-se que os cistos do ducto nasopalatino acometem usualmente homens adultos, assemelhando-se aos cistos periapicais associados aos incisivos centrais superiores e que devem ser tratados através de procedimentos cirúrgicos conservadores com posterior avaliação microscópica minuciosa do espécime removido.

Nasopalatine duct cysts are uncommon maxillary lesions that can clinically and radiographically resemble other cystic and solid lesions from the maxillary midline area. The aim of this study was to report 4 additional cases of nasopalatine duct cyst focusing on the daily clinical importance of their microscopic and differential diagnosis characteristics. Demographic, clinical and radiographic information was obtained from the patient´s laboratory registries and hematoxilin and eosin stained histological slides from all cases were reviewed under light microscopy. The 4 cases affected males with a mean age of 53 years and all lesions were asymptomatic. Radiographic images were radiolucent and unilocular, between the roots of the upper central incisors measuring a mean of 2,0 cm (ranging from 1,0 to 4,0 cm). All cases were managed through surgical enucleation and microscopic analysis revealed that 3 of the 4 cases were lined by more than one epithelium type, the most common being stratified squamous epithelium. In conclusion, nasopalatine duct cyst usually affect adult males, are similar to periapical cysts associated to upper central incisors, and should be managed by conservative surgical approach followed by careful microscopic evaluation of the surgical specimen.

Comparative clinicopathological study of intraoral sebaceous hyperplasia and sebaceous adenoma.

OBJECTIVE: The objective of this study was to compare the clinicopathological features of oral sebaceous hyperplasia and sebaceous adenoma. STUDY DESIGN: Clinical data, microscopical characteristics, and ki-67 immunoexpression were comparatively analyzed on 2 intraoral sebaceous adenomas, 6 intraoral sebaceous hyperplasias, and 21 normal intraoral sebaceous glands. RESULTS: Clinically, sebaceous glands presented as multiple separated papules, sebaceous hyperplasias as a single enlarged papule, and sebaceous adenoma as a well-defined nodule. Microscopically, sebaceous adenoma presented an increased number of lobules, smaller lobules, and a greater number of germinative/squamous cells. Sebaceous hyperplasia also had an increased number of lobules and fewer number of germinative/squamous cells, as compared to normal oral sebaceous glands. Ki-67 expression was seen only in germinative cells and counts were higher in sebaceous adenomas followed by hyperplasias and normal glands. CONCLUSIONS: Sebaceous hyperplasias and adenomas showed different clinical, microscopic, and proliferative characteristics, suggesting the usefulness of the studied criteria on diagnosis of these uncommon oral lesions.

Fine-needle aspiration biopsy as an auxiliary diagnostic tool on intraoral minor salivary gland adenoid cystic carcinoma.

BACKGROUND: Fine-needle aspiration biopsy (FNAB) is useful in diagnosis of major salivary gland adenoid cystic carcinoma (ACC), but it has been rarely reported on minor salivary gland ACC. OBJECTIVE: The aim of this study was to report the utility of FNAB on diagnosis of ACC involving minor salivary glands. STUDY DESIGN: Three patients presenting ACC involving the palate (2 cases) and buccal mucosa (1 case), with a mean age of 36 years and 2:1 female-to-male ratio, were included in the study. All of the patients were submitted to FNAB for diagnostic purposes. RESULTS: All smears were stained with hematoxylin-eosin, Papanicolaou, and Diff-Quik and showed the presence of small polyhedral cells with hyperchromatic nuclei and extracellular basophilic globular amorphous substance, compatible with ACC. Diagnosis of the 3 cases was subsequently confirmed through histopathology. CONCLUSION: The FNAB was easy to perform and cost-effective, and proved to be an useful adjunctive tool in diagnosis of intraoral ACC.

Cisto paradentário: importância dos achados clínicos, radiográficos,trans-cirúrgicos e microscópicos no diagnóstico / Paradental cyst: the importance of clinical, radiological, surgical and microscopic features on diagnosis

O cisto paradentário é um cisto odontogênico inflamatório incomum localizado aderido à junção amelo-cementária,possivelmente originado de remanescentes do epitélio reduzido do órgão do esmalte ou de restosepiteliais no periodonto. Localiza-se preferencialmente na região de trígono retromolar associado a terceirosmolares semi-inclusos com história de pericoronarite prévia. Apresenta-se como uma lesão radiolúcida bemdelimitada adjacente a dentes semi-inclusos, usualmente localizada distalmente a estes. Seu diagnósticodiferencial inclui o cisto radicular inflamatório lateral a raiz e o cisto dentígero inflamado, e o tratamento incluia remoção cirúrgica conservadora, quase sempre associada a remoção dos dentes associados. O objetivodeste trabalho é apresentar dois casos clínicos de cisto paradentário acometendo terceiros molares, ressaltandosua dificuldade diagnóstica microscópica e a necessidade da avaliação conjunta dos dados clínicoradiográficose trans-cirúrgicos. Ambos os casos apresentavam-se como áreas radiolúcidas unilocularesbem delimitadas localizadas distalmente aos terceiros molares inferiores do lado direito. O tratamento deambos os casos incluiu a remoção cirúrgica dos cistos e dos dentes associados e ambos os pacientes nãomostraram sinais de recidiva local. O cisto paradentário é um cisto incomum, de diagnóstico complexo, quenecessita de informações clínicas e imaginológicas adequadas para seu diagnóstico, devendo ser tratadode forma cirúrgica conservadora, com excelente prognóstico.

Paradental cyst is an uncommon inflammatory odontogenic cyst adhered to the enamel-cementum junction,possibly originated from remnants of the reduced enamel epithelium or epithelial remnants on the periodontium.It is usually located adjacent to the distal portion of partially-erupted lower third molars with previoushistory of pericoronaritis, as a radiolucent unilocular well-defined area. Differential diagnosis includes lateralradicular inflammatory cyst and lateral inflammed dentigerous cyst, and treatment includes conservative surgicalexcision almost always associated to removal of the associated tooth. The aim of this paper is to presenttwo cases of paradental cyst, both associated to lower third molars, discussing their microscopical diagnosticdifficulties and the importance of clinical, radiological and surgical information. The two cases presented aswell-defined unilocular radiolucences distal to the teeth, and treatment included surgical removal of the cystsand associated teeth, with no signs of recurrence until now. Paradental cyst is an uncommon cyst, whichneeds adequate clinical and imaginological information for correct final diagnosis, and should be managedthrough conservative surgery, with excellent prognosis.

Cisto nasolabial: importância do diagnóstico diferencial / Nasolabial cyst: importance of differential diagnosis

O objetivo deste trabalho é relatar um caso de cisto nasolabial discutindo a importância de seu diagnóstico diferencial. Mulher de 44 anos apresentou aumento de volume assintomático no lábio superior do lado direito com duração de três meses. O exame radiográfico mostrou a presença de uma área radiolúcida próxima aos ápices dos dentes 12 e 13 e todos os dentes da região mostravam vitalidade pulpar. Biópsia incisional da lesão mostrou diagnóstico de cisto nasolabial, confirmado após sua remoção completa sob anestesia geral. A paciente permanece em acompanhamento há 24 meses sem sinais de recidiva local.

Sialolitíase: aspectos clínicos e sócio-demográficos de 10 casos / Sialolithiasis: clinical and socio-demographic features of 10 cases

Sialolitíases são alterações frequentes das glândulas salivares. O objetivo deste trabalho é apresentar as características sócio-demográficas, clínicas, imaginológicas e de tratamento de 10 casos de sialolitíase atendidos em um ambulatório de Estomatologia. Homens adultos representaram o grupo de predileção e a glândula mais acometida foi a submandibular. Aumento de volume local, dor e infecção local foram frequentes e os exames de imagem utilizados no diagnóstico incluíram especialmente radiografias panorâmicas e oclusais inferiores e ultra-sonografias. O tratamento realizado inclui manobras clínicas e remoção cirúrgicas dos sialolitos, eventualmente associados à remoção da glândula afetada, sem evidências de recidiva nos 10 casos.

Tumor odontogênico adenomatóide associado à cisto dentígero: relato de um caso e revisäo da literatura / Adenomatoid odontogenic tumor associated with a dentigerous cyst: a report of a case and review of the literature

É apresentado um caso de Tumor Odontogênico Adenomatóide que se desenvolveu na cápsula de um cisto dentígeno. Säo discutidas as opçöes de tratamento mais comuns na literatura odontológica, levando em consideraçäo o aspecto do tratamento radical em contraposiçäo ao conservador, no qual o dente envolvido à aproveitado